Serum calprotectin and joint ultrasound in the definition of disease relapse in non-systemic juvenile idiopathic arthritis: a prospective longitudinal study.

OBJECTIVES: The aim of our study was to investigate the role of serum calprotectin (SC) and muscle-skeletal ultrasound (MSUS) as predictive markers of relapse in patients with juvenile idiopathic arthritis (JIA). METHODS: Sixty non-systemic (ns) JIA patients in clinical remission were recruited to evaluate the risk of disease relapse. SC levels and JIA disease activity were assessed at every visit (3, 6, 12 and 18 months). Joint synovitis, characterised by both synovial effusion (SE) and synovial hyperplasia (SH), was measured by US score (sum of SE, SH, power Doppler and bone erosions) given to each examined joint and US ratio (US score/number of joints examined) at every visit. Associations of SC, US score and US ratio with relapse prevalence was studied longitudinally by using generalised estimating equations model. RESULTS: Thirty-one (51.6%) patients relapsed within 18 months. Patients with higher baseline US scores showed higher risk of relapse at 6 months (OR (95% confidence interval (CI)): 1.96 (1.09-3.52)). Additionally, patients with higher SC values at baseline showed higher risk of relapse at 18 months (1.66 (1.13-2.44)). Patients with higher baseline SC values showed an increased overall odds of relapse up to 18 months of follow-up (1.21 (1.08-1.36)). Furthermore, patients with higher US scores showed an increased overall odds of relapse up to 18 months of follow-up (1.96 (1.56-2.46)). Similarly, patients with higher US ratio showed an increased overall odds of relapse up to 18 months of follow-up (16.62 (7.17-38.54)). CONCLUSIONS: SC was able to identify JIA patients with unstable remission and increased risk of relapse. MSUS represents an interesting additional tool to the clinical evaluation, especially in predicting early relapse.

In Vivo Three-dimensional Morphological Assessment of Adult Knee Menisci: A Computed Tomography-based Approach.

AIM: The present study aimed to examine meniscal morphology in an adult population in vivo through computed tomographic images, including research into morphological differences related to osteoarthritis, ageing and the meniscal location within the knee joint and a proposal for a supplementation of the current morphological classification. MATERIALS AND METHODS: Computed tomographic images of the knee for 118 patients were retrieved from the picture archiving and communication system of our Institute and included in this retrospective study. Each meniscus was subject to manual segmentation and converted into three-dimensional surfaces. The degree of osteoarthritis was determined for both the medial and lateral compartments of the knee. Statistical analysis was performed to search for any morphological difference related to osteoarthritis, ageing or the meniscal location within the knee joint. Furthermore, additional subcategories of the current morphological classification were proposed and applied to each meniscal reconstruction. RESULTS: We did not observe the presence of discoid or V-shaped menisci. No statistically significant difference was found related to osteoarthritis, ageing or the meniscal location within the knee joint. A prevalence of morphological subcategories indicating a symmetry of the width of the anterior and posterior horns, both with rounded shape, emerged. CONCLUSION: Taking advantage of non-invasive imaging, this research gives new insights into the morphology of knee menisci in an adult population in vivo. Discoid menisci were rare in our sample and the frequency of V-shaped menisci may have been overestimated in previous studies. Osteoarthritis and ageing may not influence meniscal morphology and no significant morphological differences between lateral and medial menisci were observed. The suggested classification integrates the currently used meniscal morphological classification, increasing the quantity of anatomical information on the menisci of the knee joint, thus improving diagnosis and patient treatment.

Serum Calprotectin a Potential Biomarker in Juvenile Idiopathic Arthritis: A Meta-Analysis.

Juvenile idiopathic arthritis (JIA) is the most common inflammatory chronic disease affecting children and adolescents. Today, there are no specific biomarkers of inflammation. Therefore, it is important to identify new markers as predictors of disease activity. Recently, some researchers have directed their interest toward a protein, calprotectin (CLP), as a potential biomarker. The primary objective of our systematic review and meta-analysis was to analyze the possible role of CLP in JIA. METHOD: A literature search was conducted using PubMed, EMBASE, Scopus, Science Direct on 10 August 2021. The selection of studies was made using the PRISMA 2020 guidelines. Cohen's d with 95% CI and p-value were used as a measure of effect size. The random effects model was used to account for different sources of variation among studies. Heterogeneity was assessed using Q statistics and I2. The publication bias was analyzed and represented by a funnel plot, and funnel plot symmetry was assessed with Egger's test. RESULTS: Our results at follow-up showed a statistically significant difference between patients with active disease compared to patients with inactive disease: 0.39 (0.16; 0.62), p = 0.001; without statistical heterogeneity. Another important aspect that emerged were the differences between the systemic disease form and any form of inactive disease showing a different concentration of calprotectin: 0.74 (0.40; 1.08), p < 0.001; without statistical heterogeneity. On the other hand, meta-regression analyses performed on gender, age, duration of disease, percentage of patients with ANA+ or RF+, medium value of ESR or CRP were not statistically significant. A statistically significant difference in serum calprotectin concentration between patients with JIA and healthy controls were observed. In fact, it presented lower values in the control group. CONCLUSIONS: The use of serum CLP could represent, in the future, a useful tool in JIA in order to stratify disease activity more accurately and may aid a more tailored approach to drug of choice in children with JIA. Further studies are needed to evaluate CLP as a predictor of flare in combination with other potential biomarkers of subclinical disease activity.

Bone marrow magnetic resonance imaging: physiologic and pathologic findings that radiologist should know.

Magnetic resonance imaging (MRI) plays a leading role in the non-invasive evaluation of bone marrow (BM). Normal BM pattern depends on the ratio and distribution of yellow and red marrow, which are subject to changes with age, pathologies, and treatments. Neonates show almost entirely red marrow. Over time, yellow marrow conversion takes place with a characteristic sequence leading to a red marrow persistence in proximal metaphyses of long bones. In adults, normal BM is composed of both red (40% water, 40% fat) and yellow marrow (15% water, 80% fat). Due to the higher content of fat, yellow marrow normally appears hyperintense on T1-weighted (T1w) fast spin echo (FSE) sequences and hypo-/iso-intense in short tau inversion recovery (STIR) T2-weighted (T2w); red marrow appears slightly hyperintense in T1w FSE and hyper-/iso-intense in STIR T2w. Pathologic BM has reduced fat and increased water percentages, resulting hypointense in T1w FSE and hyperintense in STIR T2w. In oncologic patients, BM MRI signal largely depends on the treatment (irradiation and/or chemotherapy) and its timing. BM fat and water amount and location in normal red/yellow and pathologic marrow are responsible for different signals in MRI sequences whose knowledge by radiologists may help to differentiate between normal and pathologic findings. Our aim was to discuss and illustrate the MRI of BM physiologic conversion and pathologic reconversion occurring in malignancies and after treatments in cancer patients.

Spectrum of phenotypic anomalies in four families with deletion of the SHOX enhancer region.

BACKGROUND: SHOX alterations have been reported in 67% of patients affected by Léri-Weill dyschondrosteosis (LWD), with a larger prevalence of gene deletions than point mutations. It has been recently demonstrated that these deletions can involve the SHOX enhancer region, rather that the coding region, with variable phenotype of the affected patients.Here, we report a SHOX gene analysis carried out by MLPA in 14 LWD patients from 4 families with variable phenotype. CASE PRESENTATION: All patients presented a SHOX enhancer deletion. In particular, a patient with a severe bilateral Madelung deformity without short stature showed a homozygous alteration identical to the recently described 47.5 kb PAR1 deletion. Moreover, we identified, for the first time, in three related patients with a severe bilateral Madelung deformity, a smaller deletion than the 47.5 kb PAR1 deletion encompassing the same enhancer region (ECR1/CNE7). CONCLUSIONS: Data reported in this study provide new information about the spectrum of phenotypic alterations showed by LWD patients with different deletions of the SHOX enhancer region.